Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

Treatment Options - Electroconvulsive

Electroconvulsive therapy (ECT) is a treatment procedure where an electric current is sent through your brain, causing a surge of electrical activity. ECT can be beneficial in the treatment of treatment-resistant depression, major depressive disorder, schizophrenia, and bipolar disorder when other treatment options have been ineffective.

Due to its relative safety compared to some medications, it is often a treatment that is safe to use for patients with severe depression who are pregnant. 

The gentle electrical stimulation during treatment is thought to reset some of the pathways in your brain that are causing severe psychiatric symptoms. ECT is usually under anesthesia, so patients are comfortably asleep during the procedure. 

How ECT Works

Patients with severe psychiatric illnesses are at high risk for suicide or suicide attempts, and the risk of death or serious injury are substantially higher than for the general population. According to research, patients who expressed suicidal intent saw a marked and rapid improvement of symptoms with ECT treatment. 

ECT may be recommended for use in cases where the patient has a history of severe, long-lasting depression, mania, or a movement disorder called catatonia (a state of frozen shock or abnormal movements). 

Depression is linked to altered messaging between brain cells, which are carried out by chemicals called neurotransmitters.  For example, some neurotransmitters, such as dopamine, may be lower in patients with depression, causing limitations in essential functions such as concentration, motivation, and pleasure. 

The electrical stimulation received by the brain during ECT has anti-depressive effects that can help alleviate symptoms and bring about changes in these functions.

Prepare for ECT

Before ECT is suggested, the physician will check the patient’s medical history and carry out detailed tests, such as a blood test and electrocardiogram (ECG), to ensure the safety of the procedure.

On the day before treatment, patients are advised not to eat or drink anything after midnight. Additionally, smoking should be avoided on the day of treatment.

What to Expect During ECT

ECT sessions are carried out with the involvement of multiple healthcare providers, including a psychiatrist, a specialist in anesthesia, and other trained personnel. Before the treatment begins, the patient is administered general anesthesia, which eliminates any discomfort, anxiety, or pain during treatment. 

A healthcare provider will then place two hand held devices against against the skin on the patient’s head. The placement is determined based on the patient’s specific condition and needs. 

A short, gentle electric current is then passed through the handheld devices for a few seconds while the patient’s brain waves are monitored. Typically, the provider starts the current at a very low level and increases it until the desired effects are seen in the brain waves. The lowest effective current based on brain wave measurements is used. 

Most patients regain consciousness within 10 to 15 minutes after the anesthesia wears off. Patients are usually able to walk around normally in 30 minutes. Patients can expect to see improvements in their symptoms after about six sessions with ECT.

Duration of ECT Treatment

ECT treatment usually involves multiple treatment sessions in the space of a week. Typically, patients may undergo ECT treatment up to three times a week for multiple weeks. 

As the treatment becomes effective, the treatments may be spaced further and further apart. Usually, the average number of treatments is around 10, but this can vary between about 4 to 20 total treatments. The number of treatments will depend on a patient’s specific condition and response to the treatment. 

ECT Safety and Effectiveness

ECT is a safe and effective treatment option for reducing symptoms of severe mental illness. During treatment, brain waves are carefully monitored using an electroencephalogram (EEG), which records the electrical activity in your brain.

This helps the provider administering treatment to ensure that only the lowest effective amount of electricity is used on the patient. The dosage is individualized for each patient and always within the safe range.

Unfortunately, a lot of misinformation about ECT abounds due to continued misrepresentation of the procedure in popular culture - through movies and TV. For a layperson who may have information about ECT only from what is viewed in the media, ECT can seem like a frightening proposition. 

However, ECT is registered as an extremely safe and effective procedure within the medical community. In fact, in some cases ECT is considered safer than antidepressant or antipsychotic medication for some patients who are elderly, pregnant, or breastfeeding

While ECT can be very effective for patients with severe mental illness. To prevent symptoms from recurring, most patients will be advised to continue with some type of maintenance treatment. This can include medication, talk therapy, or ongoing, less frequent ECT treatments (in specific cases).

Side Effects of ECT

On waking up after the treatment, it is normal for patients to feel some confusion. This is usually a result of the treatment, and the confusion clears after a short while. Some patients may experience nausea, which may persist for a few hours. Over-the-counter painkillers may be recommended for any headaches. 

Patients may experience some temporary cognitive side effects during or after ECT treatments. They may have difficulty learning and making new memories for a few weeks or months. However, these symptoms return to baseline for most patients a few weeks or months after treatment.

Long-term memory can also be affected, but it typically returns to baseline within 6 months. Side effects differ amongst the patient population, and it is best for patients to talk to their psychiatrist about their specific case. 

Risk Factors for ECT

Although ECT is a safe procedure, it is not suitable if the patient has medical conditions, such as:

  • Recent heart attack or other unstable heart condition
  • Conditions that increase the pressure inside your skull (ex: brain tumor)
  • Recent stroke, brain aneurysm, or other cause of bleeding in the brain
  • Severe lung disease

Do you have more questions about ECT?

Options MD can help! If you have had unsuccessful experiences with antidepressant medication and psychotherapy, you might be a candidate for Electroconvulsive Therapy (ECT). 

If you are a candidate for ECT, your Options MD clinician can help match you with a local in-office service that specializes in ECT. Get in touch today to find out more about your treatment options.

If you would like to interact with others in the same position as you, we also started the largest community of people with severe and treatment-resistant depression. It is a safe, collaborative, and supportive place to learn about better medication options and leading-edge treatments.

Text today to get access to qualified doctors. Alternatively, join our online community to find friendship and support. 

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